St. Paul’s Hospital is a quaternary care cardiac referral centre located in Vancouver, B.C. The Heart Centre at St. Paul’s Hospital is a unique resource for the province of B.C., providing comprehensive cardiac care, including cardiac transplant and LVAD support. The centre treats approximately 20-30 VA ECMO cases per year, and has an established history of providing ECMO-CPR (ECPR) services to in-hospital cardiac arrests.
In June of 2015 St. Paul’s Hospital approved the creation of a formal ED-based ECPR service for out-of-hospital cardiac arrest (OHCA) that went live on January 1, 2016– the first of its kind in Canada. It was recognized that a highly organized system, with close collaboration between pre-hospital and multiple in-hospital services, would be required to identify appropriate out-of-hospital cardiac arrest patients and implement ECPR in a time-frame that could lead to favourable neurological outcomes. With these goals a program was developed, with the mandate to improve the likelihood of neurologically intact survival among patients with sudden unexpected cardiac arrest that is refractory to standard therapies. Although ECPR for patients treated with this service is initiated in the ED, this is a close collaboration with Cardiac Surgery and Perfusion Services, Interventional Cardiology, Intensive Care, and Cardiac Anesthesiology. The protocol is live 24 hours a day, seven days a week.
A partnership was formed between BC Emergency Health Services (BCEHS), the sole provider of prehospital medical care in B.C., and the St. Paul’s Hospital ECPR Service. May 24, 2016 marked the start of a regional ECPR protocol in Vancouver and the north shore, in which the provision of ECPR was formally incorporated into the management algorithm for out-of-hospital cardiac arrest. For all eligible patients remaining in refractory arrest after initial failed on-scene resuscitative efforts the St. Paul’s Hospital ECPR protocol is activated, the Lucas chest compression device applied, and the patient is transported to hospital. Upon arrival at hospital ECMO is rapidly initiated, with the goal of achieving ECMO flows in under 60 minutes from the arrival of paramedics at the scene of the cardiac arrest.
“In the Vancouver area, paramedics treat about 400 cardiac arrests per year, and it was shocking to learn that one-third of those patients are under the age of 60. This complex program is a joint venture between multiple programs in our hospital, namely cardiovascular surgery, perfusion, critical care, cardiology and the emergency department. It represents a high level of co-operation and dedication.
– Dr. Dan Kalla, Head of Emergency Medicine at Providence Healthcare.
“While ECMO is occasionally used for patients already in the hospital, this protocol is the first in Canada to use ECMO on those who suffer out-of-hospital cardiac arrest.”
– Dr. Anson Cheung, Surgical Director of Cardiac Transplant and Mechanical Circulatory Assist Device of BC.